EndoVascular Occlusion and Tumor Excision (EVOTE): a Hybrid Approach to Small-Bowel Neuroendocrine Tumors with Mesenteric Metastases

Julian K. Horwitz, Michael L. Marin, Richard R.P. Warner, Robert A. Lookstein, Celia M. Divino

Research output: Contribution to journalArticlepeer-review

4 Scopus citations


Background: Mesenteric metastases from small-bowel neuroendocrine tumors (SBNETs) present a surgical challenge due to encasement of mesenteric vessels. In this study, we evaluate the feasibility and safety of a new, hybrid surgical approach to these mesenteric masses, EndoVascular Occlusion and Tumor Excision (EVOTE). Methods: From 2014 to 2018, 13 patients underwent the EVOTE procedure after being referred to our institution for primary SBNETs with “unresectable” mesenteric metastases. During stage 1 of the hybrid EVOTE procedure, angiographic evaluation of the mesenteric mass is performed. If adequate collateralization is demonstrated, the encased mesenteric vessel(s) is embolized. Mass excision is performed the following day during stage 2 of the EVOTE procedure. Results: Preoperative embolization was successful in 86% of cases; 2 cases were aborted for persistent abdominal pain following occlusion testing. Complete surgical excision of the mesenteric mass was achieved in 86% of cases. The 30-day overall morbidity and mortality rate was 29% and 0%, respectively. There was one local recurrence at 31.8 months post-op; this patient underwent a repeat EVOTE procedure with successful complete excision. Discussion: EVOTE represents a new technique that aids in preoperative planning and surgical resection of SBNETs with mesenteric metastases.

Original languageEnglish
Pages (from-to)1911-1916
Number of pages6
JournalJournal of Gastrointestinal Surgery
Issue number9
StatePublished - 15 Sep 2019


  • Mesenteric metastases
  • Metastatic carcinoid
  • Surgical management carcinoid
  • Unresectable carcinoid


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